Can we manage type 1 diabetes without insulin?

April 13, 2011

Traditional answer to this question is NO. Now a new study may be opening the path to a Type 1 life without insulin.

This is not a cure, but a potential alternative to insulin. Diabetes in Control reported that “Another hormone, fibroblast growth factor 19 (FGF19), has insulin-like characteristics beyond its role in bile acid synthesis. Unlike insulin, however, FGF19 does not cause excess glucose to turn to fat, suggesting that its activation could lead to new treatments for diabetes or obesity.”

FGF19 does not make fat, and that’s one of the effects that separates it from insulin. Insulin also does not really have a dramatic effect on bile acid synthesis. So, the two pathways are different even though they both function in glycogen and protein synthesis.

Manipulating FGF19 as an alternative to insulin therapy remains a daunting challenge, however, given some unwelcome side effects. In some studies, he said, activating the hormone in rodents caused the liver to grow and develop cancer.

One promising diabetes treatment route could involve the nuclear bile acid receptor FXR, which Dr. Mangelsdorf said induces expression of FGF19. Modulators of FXR (farnesoid X receptor) have been shown to lower triglycerides and improve cholesterol profiles in preclinical models.

Hopefully this is not another of those studies that are very promising in mice but never make it to humans. Unfortunately we probably will have to wait many years to find out.